<div class="modal fade" id="modalRequest" tabindex="-1" role="dialog" aria-labelledby="modalRequestLabel"
     aria-hidden="true">
    <div class="modal-dialog" role="document">
        <div class="modal-content">
            <div class="modal-header">
                <h5 class="modal-title" id="modalRequestLabel">Request a Quote</h5>
                <button type="button" class="close" data-dismiss="modal" aria-label="Close">
                    <span aria-hidden="true">&times;</span>
                </button>
            </div>
            <div class="modal-body">
                <form action="#">
                    <div class="form-group">
                        <label for="appointment_name" class="text-black">Full Name</label>
                        <input type="text" class="form-control" id="appointment_name">
                    </div>
                    <div class="form-group">
                        <label for="appointment_email" class="text-black">Email</label>
                        <input type="text" class="form-control" id="appointment_email">
                    </div>
                    <div class="row">
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="appointment_date" class="text-black">Date</label>
                                <input type="text" class="form-control" id="appointment_date">
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="appointment_time" class="text-black">Time</label>
                                <input type="text" class="form-control" id="appointment_time">
                            </div>
                        </div>
                    </div>
                    <div class="form-group">
                        <label for="appointment_message" class="text-black">Message</label>
                        <textarea name="" id="appointment_message" class="form-control" cols="30"
                                  rows="10"></textarea>
                    </div>
                    <div class="form-group">
                        <input type="submit" value="Send Message" class="btn btn-primary">
                    </div>
                </form>
            </div>
        </div>
    </div>
</div>
